CMS to sweeten Medicare Advantage deal

The Centers for Medicare & Medicaid Services (CMS) says it is increasing its estimate of the projected change in Medicare Advantage plan per-person costs 0.4 percent for 2015.

In February, CMS had proposed using a 1.9 percent decrease in projected per-person costs in the official plan bidding documents.

CMS actuaries are now expecting the actual cost of care for the plan enrollees to fall 3.4 percent. Just a few weeks ago, the actuaries were expecting costs to fall only 1.9 percent, CMS Director Jonathan Blum said today during a conference call with reporters.

But CMS scraped up part of the 2.5-percentage-point increase in the actual bidding benchmark by changing the way it calibrates one Medicare Advantage risk management program and slowing the phase-in of another risk management program that could have decreased the benchmark, Blum said.

Blum noted that the benchmark represents an average for all plans in the Medicare Advantage program, in all geographic areas and at all quality-based reimbursement rate levels.

The projected per-capita cost change benchmark is just one component of a Medicare Advantage plan rate proposal, Blum added.

America’s Health Insurance Plans (AHIP) analyzed the figures CMS included in its original 2015 Medicare Advantage program proposal and said it believed the overall proposed benchmark decrease was really 5.9 percent, not 1.9 percent.

At press time, AHIP had not reacted to the CMS announcement about the 0.4 percent benchmark increase or weighed in on what insurers think the benchmark change really is.